Quality and usability of arthritic pain self-management apps for older adults: A systematic review

© 2017 American Academy of Pain Medicine. Objective. To appraise the quality and usability of currently available pain applications that could be used by community-dwelling older adults to selfmanage their arthritic pain. Methods. A systematic review. Searches were conducted in App Store and Google Play to identify pain self-management apps relevant to arthritic pain management. English language pain management apps providing pain assessment and documentation function and pain management education were considered for inclusion. A quality evaluation audit tool based on the Stanford Arthritis Self-Management Program was developed a priori to evaluate app content quality. The usability of included apps was assessed using an established usability evaluation tool. Results. Out of the 373 apps that were identified, four met the inclusion criteria. The included apps all included a pain assessment and documentation function and instructions on medication use, communication with health professionals, cognitive behavioral therapy-based pain management, and physical exercise. Management of mood, depression, anxiety, and sleep were featured in most apps (N =3). Three-quarters (N = 3) of the apps fell below the acceptable moderate usability score (≥3), while one app obtained a moderate score (3.2). Conclusions. Few of the currently available pain apps offer a comprehensive pain self-management approach incorporating evidence-based strategies in accordance with the Stanford Arthritis Self- Management Program. The moderate-level usability across the included apps indicates a need to consider the usability needs of the older population in future pain self-management app development endeavors

Telemedicine Scenario for Elderly People with Comorbidity

Progressive population aging is associated with negative social and economic impacts mainly due to its associated comorbidity rather than to aging per se. In this regard, information and communication technology resources may provide useful tools to assist the population with comorbidities through the use of telemedicine systems. However, despite their potential, such systems have not yet been effectively implemented due to a number of different reasons: absence of a clear business plan, poor acknowledgement of their clinical usefulness, and ethical and legal issues, among others. An analysis of current scenario from the point of view of the different actors (patients, health care providers, and health care systems) aimed at identifying the needs to be covered by telemedicine systems that could contribute to overcoming such problems. The present chapter is intended to offer such an analysisPostprint (author’s final draft

Palliasjon i rurale strøk: lindrende omsorg for eldre kreftpasienter som bor hjemme. En systematisk litteraturstudie

Det finnes generelt lite kunnskap om eldre med kreft, og spesielt når kreften når et avansert stadium og krever palliativ tilnærming. Samtidig som det kan forventes at geografiske helseulikheter vil øke i takt med en økende eldre befolkning, anses kunnskapen vi har om den rurale konteksten å være sparsom og utvelgende. Dette litteratursøket ønsker derfor å sette søkelys på hva vi vet om palliativ omsorg for hjemmeboende eldre som bor i rurale strøk: Hva består tilbudet av? Hvilke erfaringer har brukere og pårørende som mottar palliative tjenester i rurale strøk, og også hvilke utfordringer erfarer helsepersonell i denne konteksten

Using Digital Health Technology to Optimise Older People’s Pain Self-Management Capabilities: A Mixed Methods Study (The DigiTech Pain Project)

Background Arthritic pain is a major cause of illness and disability among older people. As the use of smartphones and apps increases in the lives of older people, there is an opportunity to explore the role of these apps in helping older people better manage their arthritic pain. Aim To explore the feasibility and acceptability of older people using an arthritic pain selfmanagement app to improve their pain symptoms. Methods A parallel convergent, mixed methods design underpinned by Bandura’s Self-Efficacy Theory and the Technology Acceptance Model 2; comprising of the following five studies: (i) Study 1a: an integrative review; (ii) Study 1b: a systematic review; (iii) Study 2a: a phase I feasibility study of pre–post-test design; (iv) Study 2b: a qualitative sub-study involving participants of study; and (v) Study 3: a qualitative interview study with primary care and allied health clinicians. The data from these studies was integrated to answer the project’s research questions. Results Study 1a revealed paucity of evidence on use of apps for older people’s pain selfmanagement. Study 1b indicated that few publicly available pain self-management apps are based on robust evidence. Eighteen older people were recruited into Study 2a, 80% via snowballing. Over 59% of participants were provided face-to-face app download and use training, none had used a pain self-management app in the past. Telephone-based survey and interview data collection was found to be acceptable to older people. Almost 90% of study 2a participants (n=16) took part in study 2b sharing their experiences of using the intervention app. Following four themes emerged: (i) Apps are valuable selfmanagement tool, but they do have the potential for harm; (ii) pain self-management apps need to be strictly relevant to the user; (iii) Clinicians’ involvement is crucial; and (iv) pain self-management apps must be designed with the end user in mind. Study 3 recruited seventeen (n=17) primary care and allied health clinicians who shared their perceptions and attitudes regarding app use by their older patients for pain self-management. Four themes emerged: (i) self-management apps are a potentially useful tool but require careful consideration; (ii) clinicians’ involvement is crucial yet potentially onerous; (iii) no single app is right for every older person; and (iv) patient data access is beneficial but caution is needed for real-time data access. Meta-inference of the data from all five studies indicated that an app intervention involving older people was both feasible and acceptable, with the following caveats: snowballing recruitment may be required; and access to app download and use training is an important element to implement into the study design. Older people and primary care clinicians were keen to engage with pain self-management apps; however, they wanted these apps to offer high level usefulness, adaptability and information sharing features. Future pain self-management apps need to be underpinned by robust evidence, while providing appropriate support and resources to clinicians. Conclusion While older people and their clinicians welcomed the opportunity to use pain self-management apps, their engagement ought to be supported by systems level policies, and high-quality apps. Collaboration among clinicians, older people, researchers and app developers ought to be considered when developing, researching and integrating pain self-management apps

Information technologies for pain management

Millions of people around the world suffer from pain, acute or chronic and this raises the importance of its screening, assessment and treatment. The importance of pain is attested by the fact that it is considered the fifth vital sign for indicating basic bodily functions, health and quality of life, together with the four other vital signs: blood pressure, body temperature, pulse rate and respiratory rate. However, while these four signals represent an objective physical parameter, the occurrence of pain expresses an emotional status that happens inside the mind of each individual and therefore, is highly subjective that makes difficult its management and evaluation. For this reason, the self-report of pain is considered the most accurate pain assessment method wherein patients should be asked to periodically rate their pain severity and related symptoms. Thus, in the last years computerised systems based on mobile and web technologies are becoming increasingly used to enable patients to report their pain which lead to the development of electronic pain diaries (ED). This approach may provide to health care professionals (HCP) and patients the ability to interact with the system anywhere and at anytime thoroughly changes the coordinates of time and place and offers invaluable opportunities to the healthcare delivery. However, most of these systems were designed to interact directly to patients without presence of a healthcare professional or without evidence of reliability and accuracy. In fact, the observation of the existing systems revealed lack of integration with mobile devices, limited use of web-based interfaces and reduced interaction with patients in terms of obtaining and viewing information. In addition, the reliability and accuracy of computerised systems for pain management are rarely proved or their effects on HCP and patients outcomes remain understudied. This thesis is focused on technology for pain management and aims to propose a monitoring system which includes ubiquitous interfaces specifically oriented to either patients or HCP using mobile devices and Internet so as to allow decisions based on the knowledge obtained from the analysis of the collected data. With the interoperability and cloud computing technologies in mind this system uses web services (WS) to manage data which are stored in a Personal Health Record (PHR). A Randomised Controlled Trial (RCT) was implemented so as to determine the effectiveness of the proposed computerised monitoring system. The six weeks RCT evidenced the advantages provided by the ubiquitous access to HCP and patients so as to they were able to interact with the system anywhere and at anytime using WS to send and receive data. In addition, the collected data were stored in a PHR which offers integrity and security as well as permanent on line accessibility to both patients and HCP. The study evidenced not only that the majority of participants recommend the system, but also that they recognize it suitability for pain management without the requirement of advanced skills or experienced users. Furthermore, the system enabled the definition and management of patient-oriented treatments with reduced therapist time. The study also revealed that the guidance of HCP at the beginning of the monitoring is crucial to patients' satisfaction and experience stemming from the usage of the system as evidenced by the high correlation between the recommendation of the application, and it suitability to improve pain management and to provide medical information. There were no significant differences regarding to improvements in the quality of pain treatment between intervention group and control group. Based on the data collected during the RCT a clinical decision support system (CDSS) was developed so as to offer capabilities of tailored alarms, reports, and clinical guidance. This CDSS, called Patient Oriented Method of Pain Evaluation System (POMPES), is based on the combination of several statistical models (one-way ANOVA, Kruskal-Wallis and Tukey-Kramer) with an imputation model based on linear regression. This system resulted in fully accuracy related to decisions suggested by the system compared with the medical diagnosis, and therefore, revealed it suitability to manage the pain. At last, based on the aerospace systems capability to deal with different complex data sources with varied complexities and accuracies, an innovative model was proposed. This model is characterized by a qualitative analysis stemming from the data fusion method combined with a quantitative model based on the comparison of the standard deviation together with the values of mathematical expectations. This model aimed to compare the effects of technological and pen-and-paper systems when applied to different dimension of pain, such as: pain intensity, anxiety, catastrophizing, depression, disability and interference. It was observed that pen-and-paper and technology produced equivalent effects in anxiety, depression, interference and pain intensity. On the contrary, technology evidenced favourable effects in terms of catastrophizing and disability. The proposed method revealed to be suitable, intelligible, easy to implement and low time and resources consuming. Further work is needed to evaluate the proposed system to follow up participants for longer periods of time which includes a complementary RCT encompassing patients with chronic pain symptoms. Finally, additional studies should be addressed to determine the economic effects not only to patients but also to the healthcare system